Agriculture is one of the most hazardous industries in the US. A recent systematic review of farm safety interventions found little evidence of the interventions being effective. The Certified Safe Farm (CSF) program has shown exceptional potential to become a widely used effective intervention model. Our pilot results show a 17% reduction in total farm related injury and illness costs and 35% reduction in the costs covered by insurance. These results are very promising, but they are self-reported, and may be subject to bias. We propose to validate these results in this new proposed study, which has large sample sizes and measures success with actual health insurance claims data. Iowa Farm Bureau Federation, Wellmark Blue Cross Blue Shield of Iowa, and AgriSafe Network are our active partners. The specific aims of this project are to: 1. Enroll 600 Iowa farmers into the CSF program who are members of the Iowa Farm Bureau Federation and have Wellmark health insurance coverage through Iowa Farm Bureau Federation. 2. Provide CSF services (agricultural occupational health screenings, education, and on-farm safety reviews) to each of the enrolled farmers twice during the four-year project. 3. Provide safety and health education to CSF farm families on a continual basis. 4. Conduct retrospective and prospective analyses of health insurance claims data for the 600 CSF farmers and at least 2400 control farmers who are also Iowa Farm Bureau-Wellmark insurees. 5. Analyze the association of health outcomes and demographic, farm production, health, insurance, and farm hazard characteristics. 6. Utilize project findings to build an ongoing CSF program in collaboration with insurance and agribusiness partners. The CSF program has shown to be well received among farmers, feasible to implement, and transportable to different farming situations. It has shown to reduce farm hazards, increase the use of personal protective equipment, reduce respiratory symptoms, and decrease farm-related injury and illness costs. This proposal aims to take this program to the next level - a sustainable ongoing program linked with farm organizations, insurance companies, and agribusinesses. Positive results from this study will provide justification for the private sector to invest in the CSF program. With insurance and agribusiness participation, this program has the potential to achieve high participation rates among farmers and make a significant difference in reducing the burden of injuries and illnesses in US agriculture.